Unintended Pregnancy and Its Adverse Social and Economic Consequences on Health System: A Narrative Review Article

Article excerpt

Introduction

Unintended pregnancies are pregnancies that are mistimed, unplanned or unwanted at the time of conception. Unintended pregnancies include unwanted pregnancies at least for one of couples. Unintended pregnancy is among the most troubling public health problems and a major reproductive health issue including accidental pregnancy and defined as a pregnancy that was undesired for one or both of the partners (1). Regarding the World Health Organization (2005) approximately 210 million pregnancies occur each year worldwide of which 87 million are unplanned and 41 million continue to birth. According to the reports (2) the total number of unsafe abortion in 2008 was 21-22 million worldwide and there were 22 unsafe abortions per 1000 women aged 15-44 years. While the report on mortality due to unsafe abortion estimates 47000 maternal deaths (that is 13% of maternal mortality in 2008. Approximately fifty percent of pregnancies in United States of America are unintended and about 48% of reproductiveage American women (15-44) have experienced at least one unintended pregnancy (2, 3).

Contrary to extensive coverage of family planning in Iran and the efforts in this regard unplanned pregnancies are common problem as well. A research in different parts of Iran revealed the prevalence of unintended pregnancies to be 22% while in Ardebil it was 61% (3, 4). Another survey reported it to be 31% (of which 56% were unwanted and 44% were unplanned (5). Unintended pregnancy is also considered as a high-risk pregnancy associated with high rates of negative consequences for mother, partner and the baby. These groups of women are more exposed to suicide (6) and depression rate, poor nutrition during gestation (7), mental health issues, unstable family relationships, experiencing physical and psychological violence, risk of miscarriage and having low birth weight infants (8) and delayed onset of prenatal care )9).

Statistics show that when compared to wanted ones, unwanted children are exposed to greater risk factors, so that they more likely experience negative psychological and physical health issues and dropout of high school and tend to show delinquent behavior during adolescence (2). The participants of a research in Australia reported higher level of depression, anxiety and delinquency than compared with those in wanted children group thus child smoking were self-reported at 14- years (10).

According to several micro-level studies, a child's overall health has an impact on his or her ability to achieve academic success. Existing studies at the macro level suggest population health has a significant effect on a nation's economic performance and growth (11). Overall, the evidence suggests that unintended pregnancy is one of the most critical challenges facing the public health system and imposes significant financial and social costs on society. Long-term studies confirm that reducing unintended pregnancy incidences would increase labor force participation rates, improve academic achievement, have better economic efficiency, increase the level of health and reduce in crime rates among vulnerable groups (2, 10). Thus in this paper we focus on the socio-economic impacts of unwanted pregnancy from the viewpoint of health system.

Methods

The present narrative review focuses on socioeconomic impacts of unintended pregnancy from the health system perspective. Follow of Computerized searches of Academic,1245 scientific journals were found in various databases including PubMed, EMBASE, ISI, Iranian databases, IPPE, UNFPA (1985- 2013). Related keywords included unwanted pregnancy, economic outcomes, social outcomes, cost, socio-economic consequences, health indicators, Reproductive health. After reading to topics, 53 relevant articles were identified. During this search, 20 studies were found which met the inclusion criteria. Inclusion criteria: 1published articles in English and Persian (Original articles, review articles, published books about the purpose of the paper were used). …